How do I install the Gc Overreplacement Fracture Risk skill?

Run npx skillmds@latest add dromlakhani/gc-overreplacement-fracture-risk in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Gc Overreplacement Fracture Risk free to use?

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Who published Gc Overreplacement Fracture Risk?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Gc Overreplacement Fracture Risk by dromlakhani

Name: Gc Overreplacement Fracture Risk
Rating: 4.2 (5 reviews)
Author: dromlakhani

Gc Overreplacement Fracture Risk

Recommends vertebral fracture assessment (baseline spinal x-ray or DXA) to identify unsuspected vertebral fractures in men over-replaced with glucocorticoids and at fracture risk. Use when evaluating a male hypopituitarism patient on glucocorticoids with fracture risk factors such as age >50, prior fracture, or low BMD.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Assess vertebral fracture risk in glucocorticoid-over-replaced hypopituitarism males

STEP 1 — Gather Information

Collect patient sex, confirmation of hypopituitarism, current glucocorticoid regimen (type and daily dose), calculate hydrocortisone equivalent dose, and assess fracture risk factors (age, prior fragility fracture, BMD T‑score, hypogonadism, height loss, back pain).

STEP 2 — Rule In / Rule Out

Determine if the patient is a male with hypopituitarism, glucocorticoid over‑replaced (dose >20 mg hydrocortisone equivalent per day), and has ≥1 fracture risk factor. If yes, proceed to classification; if no, continue routine care and reassess annually.

STEP 3 — Classify or Stratify

Stratify as high risk when glucocorticoid dose exceeds 20 mg hydrocortisone equivalent daily and at least one major risk factor is present (age >50, prior vertebral fracture, BMD T‑score ≤‑1.0, or untreated hypogonadism). Otherwise classify as moderate/low risk.

STEP 4 — Decide

For high‑risk patients, obtain baseline vertebral fracture assessment via lateral thoracic‑lumbar spine radiography or DXA with vertebral fracture analysis (VFA). For moderate/low‑risk patients, optimize lifestyle, ensure adequate calcium/vitamin D, and repeat risk assessment every 12 months.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on BMD T‑score; vertebral fractures can occur without osteoporosis. Avoid missing asymptomatic fractures by ordering imaging based on risk, not only back pain. Do not substitute lumbar spine DXA lacking VFA capability for vertebral fracture assessment. Do not continue glucocorticoid over‑replacement without periodic dose reassessment.

Concrete Clinical Example

A 48‑year‑old man with hypopituitarism on hydrocortisone 25 mg daily denies back pain but has low testosterone and a prior distal radius fracture. His GC dose exceeds physiologic replacement, so he is classified as high risk. A lateral spine X‑ray reveals a mild T12 vertebral compression fracture, prompting glucocorticoid dose reduction and initiation of bone‑protective therapy.

Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2118

TODO: consider adding scripts/calc.py for the gc-overreplacement-fracture-risk calculator

---name: gc-overreplacement-fracture-riskdescription: Recommends vertebral fracture assessment (baseline spinal x-ray or DXA) to identify unsuspected vertebral fractures in men over-replaced with glucocorticoids and at fracture risk. Use when evaluating a male hypopituitarism patient on glucocorticoids with fracture risk factors such as age >50, prior fracture, or low BMD.---# Assess vertebral fracture risk in glucocorticoid-over-replaced hypopituitarism males## STEP 1 — Gather InformationCollect patient sex, confirmation of hypopituitarism, current glucocorticoid regimen (type and daily dose), calculate hydrocortisone equivalent dose, and assess fracture risk factors (age, prior fragility fracture, BMD T‑score, hypogonadism, height loss, back pain). ## STEP 2 — Rule In / Rule OutDetermine if the patient is a male with hypopituitarism, glucocorticoid over‑replaced (dose >20 mg hydrocortisone equivalent per day), and has ≥1 fracture risk factor. If **yes**, proceed to classification; if **no**, continue routine care and reassess annually. ## STEP 3 — Classify or StratifyStratify as **high risk** when glucocorticoid dose exceeds 20 mg hydrocortisone equivalent daily **and** at least one major risk factor is present (age >50, prior vertebral fracture, BMD T‑score ≤‑1.0, or untreated hypogonadism). Otherwise classify as **moderate/low risk**. ## STEP 4 — DecideFor **high‑risk** patients, obtain baseline vertebral fracture assessment via lateral thoracic‑lumbar spine radiography or DXA with vertebral fracture analysis (VFA). For **moderate/low‑risk** patients, optimize lifestyle, ensure adequate calcium/vitamin D, and repeat risk assessment every 12 months. ## Clinical Guardrails / Mimics / PitfallsDo not rely solely on BMD T‑score; vertebral fractures can occur without osteoporosis. Avoid missing asymptomatic fractures by ordering imaging based on risk, not only back pain. Do not substitute lumbar spine DXA lacking VFA capability for vertebral fracture assessment. Do not continue glucocorticoid over‑replacement without periodic dose reassessment. ## Concrete Clinical ExampleA 48‑year‑old man with hypopituitarism on hydrocortisone 25 mg daily denies back pain but has low testosterone and a prior distal radius fracture. His GC dose exceeds physiologic replacement, so he is classified as high risk. A lateral spine X‑ray reveals a mild T12 vertebral compression fracture, prompting glucocorticoid dose reduction and initiation of bone‑protective therapy. **Source:** Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2118 > **TODO:** consider adding scripts/calc.py for the gc-overreplacement-fracture-risk calculator

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